Risk factors of intracerebral hemorrhage after liver transplantation

Objictive To find out some possible risk factors of intracerebral hemorrhage after liver transplantation.Method The clinical data of 454 patients who underwent liver transplantation in the First and Third Affdiated Hospital of Sun-Yat Sen University of Guangzhou,China,from May 1996 to April 2005,were retrospectively analyzed.The criteria for the selection of patients were as follow:(1)the patients after orthotopic liver transplantation of dead donor;(2)intracerebral hemorrhage after liver transplantation;(3)all patients diagnozed by head CT or MRI;(4)patients with intracerebral hemorrhage before liver transplantation were excluded.Therefore,12 patients complicated with intracerebral hemorrhage were selected for analysis.The mean age was(56.33±10.25)years old.The other 48 patients were admitted as control group,with mean age was (50.38±10.20)years old.The analysis included:(1)general factors,including gender;age;preoperative diagnosis,hepatitis B virus surface antigen,hepatitis B virus DNA(HBVDNA),Child classification of hepatic function,coagulation tetrachoric,blood routine,hepatic function,electrolytes,intensive care unit(ICU)stay, blood pressure(BP)and central venous pressure(CVP);operating time;cold ischemia time;anhepatic phase; the amount of intraoperative blood loss;postoperative blood routine,coagulation tetrachoric,BP and CVP, complicating infection(confirmed by cultivation to find germs or fungi).(2)additional factors for intracerebral hemorrhage group:the BP and CVP before intracerebral hemorrhage;the time of tracerebral hemorrhage happened;intracerebral hemorrhage site(diagnosed by CT scan);surgical intervention outcome.Comparisons between two group was made with SPSS 12.0 for windows.Firstly,the data were analyzed with the process of single variable analysis and some parameters,which showed the significant difference,were sorted out from two groups.Then these parameters were put to the LOGISTIC regression analysis.Consequently,the independent risk factors of intracerebral hemorrhage after liver transplantation could be found.Results The single variable analysis has shown that the parameters of ICU stay,Child classification of hepatic function,hemoglobin(HB),activated partial thromhoplastin time(APTT)and albumin(ALB)before operation,the amount of intraoperative blood loss,the operative time,platelet(PLT)and activated partial thromhoplastin time(APTT)after operation shewed the significant difference(P0.05).Throngh analysis of the parameters listed with LOGISTIC regression,it could be find that Child classification of hepatic function before operation and the amount of intraoperative blood loss are the two independent risk factors of intracerebral hemorrhage(P0.05).Conclusions The Child classification of hepatic function before operation and the amount of intraoperative blood loss are essential for in prognosing the intracerebral hemorrhage after liver transplantation.